2025Acute coronary syndromesSurgeryCoronary artery disease2201 patients

TACSI

Therapy group: Antiplatelet therapy · Therapy: Ticagrelor plus aspirin vs aspirin alone after CABG for ACS

Adding ticagrelor to aspirin for one year after bypass surgery for acute coronary syndrome did not reduce ischemic events and markedly increased major bleeding.

Published in N Engl J Med (2025)

Question: Does adding ticagrelor to aspirin, compared with aspirin alone, reduce adverse cardiovascular outcomes after coronary-artery bypass grafting (CABG) for acute coronary syndrome?
Design: Open-label, registry-based randomized clinical trial (1:1) conducted at 22 Nordic cardiothoracic surgery centers, with 2201 patients and outcomes assessed at 1 year.
Population: Patients undergoing CABG for acute coronary syndrome; mean age 66 years and 14.4% women.
Intervention: Ticagrelor 90 mg twice daily plus aspirin for 1 year after surgery.
Control: Aspirin alone for 1 year after surgery.
Primary outcome: Composite of death, myocardial infarction, stroke, or repeat revascularization at 1 year.
Results: The primary outcome occurred in 53 patients (4.8%) with ticagrelor plus aspirin and 50 (4.6%) with aspirin alone (HR 1.06; 95% CI 0.72 to 1.56; P = 0.77). Net adverse clinical events occurred in 9.1% vs 6.4% (HR 1.45; 95% CI 1.07 to 1.97).
Safety: Major bleeding was more frequent with ticagrelor plus aspirin (4.9%) than with aspirin alone (2.0%) (HR 2.50; 95% CI 1.52 to 4.11).
Conclusion: Among patients undergoing CABG for acute coronary syndrome, adding ticagrelor to aspirin did not lower the incidence of death, myocardial infarction, stroke, or repeat revascularization at 1 year and increased major bleeding.
Why it matters: The trial challenges routine dual antiplatelet therapy with ticagrelor after CABG for acute coronary syndrome, as it offered no ischemic benefit while increasing bleeding risk.

Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.

Generated on October 14, 2026

Sources

Original publication on PubMed (PMID 40888737) ↗Ticagrelor and Aspirin or Aspirin Alone after Coronary Surgery for Acute Coronary Syndrome.
Journal article (DOI) ↗
ClinicalTrials.gov record (NCT03560310) ↗

Videos explaining it

Hot Line 10 – TACSI

ESC · European Society of Cardiology ↗1:55Video page

Source: European Society of Cardiology · YouTube
Date: 1 Sept 2025
Audio: English
Subtitles: MultilingualYouTube
Audio transl.: Unconfirmed · check ⚙YouTube

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Podcasts explaining it

TACSI Trial: Dual or Single Antiplatelet Therapy After CABG in Patients With ACS
ACC · ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research ↗9 minEpisode page
Source
ACC · Apple Podcasts
Date
11 Nov 2025
Audio
English
Translation
TextGoogle Chrome
Audio transl.
None

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